In a guest column for the Joplin Globe (1/30/2011) Anson Burlingame discusses the financial ramifications of the end-of-life issue as it bears on MediCare and taxpayers. In my opinion he does a good job in summing up the problem but as you will read here,I respectfully disagree with his solution. First, I will offer this summary of his column, but in my own words:

The costs of medical care with its modern technologies have outstripped our capacity to afford them.

A disproportionate part of these burgeoning costs come near end-of-life (EOL) as that often entails such things as ICU care and extensive testing such as CAT and MRI imaging.

Typically, many of the expensive EOL efforts have little success and often even prolong suffering by both patient and family.

Viable solutions to the cost problem appear to be missing from either the medical establishment or politicians.

The political right (GOP) has formally rejected the Obama administration’s attempt at dealing with health care (ACA), including any notion of funding EOL counseling by government, but has thus far not specifically revealed how they plan to deal with the cost issue. However, the GOP has in the past favored measures intended to increase competition in the health-care insurance industries to deal with the problem.

Anson asks, “Why would or should any responsible physician charge anyone for end-of-life counseling?” and concludes that, “Doctors and patients alone should make

that decision. And no one should pay for that discussion or charge for it. Period.”

Caduceus, via Wikipedia

I have problems with his solution. One is that doctors, and hospitals too for that matter, may have conflicts of interest and also may not be emotionally or professionally motivated to deliver EOL counseling well. Medicine in America is big business, and it has become increasingly specialized. Our own family physician recently told me that he will no longer visit his patients while they are in the hospital. That function is now performed by physician-specialists called “hospitalists”. Why? He said that it was a matter of time efficiency.

My great-great-grandfather was the self-taught country doctor of Berryville, Arkansas in the mid-nineteenth century. He made house calls and sometimes forgave payment. By all accounts he was much-loved and honored in his community. That’s all gone today of course. Doctors now sometimes band together in their specialty businesses, one local example being “Orthopaedic Specialists of the Four States, LLC”. This group has recently constructed a new facility just across the Kansas state line from Joplin in Galena, a tiny town. I assume there is a financial advantage to the location and I also assume they have invested in their own imaging and testing equipment.

What evidence is there that profit is a lively topic of interest to doctors? Here is one LINK to that effect.

Image by EssG via Flickr

Now, I would not criticize doctors for wanting to maximize their earnings if the system involved fair capitalist competition, but in many cases it does not. Once in the system, patients have few options and no incentive to question costs. They in fact are dealing with the system as we have it, a system that in my opinion is deeply flawed because by its very nature it enables conflicts of interest and lacks competition. Here is a LINK which details an instance where a doctor referred his patient to a lab for a CT scan without revealing that he had a personal interest in the lab. Was this legal? Apparently. Was it ethical? Not in my opinion, nor in the writer’s.

Another serious flaw in the current system is that new doctors typically graduate with a mountain of college and medical-school debt and are no-doubt very anxious to pay it off. That, in my opinion, is not an appropriate motivation with which to begin a career in helping humanity.

Image via Wikipedia

Here is an example of medical conflict of interest in a case investigated by the Wall Street Journal. In certain spinal-fusion operations in Louisville, Kentucky, journalists discovered “strong ties between the surgeons and medical-device manufacturers. The REPORT mentioned that, “. . . in the first three quarters of 2010, the WSJ reports that each of five spinal surgeons at Norton hospital in Louisville Kentucky received more than $1.3 million from Medtronic – the leading manufacturer of spinal fusion devices.”

The same report later said this. “According to the WSJ’s analysis of Medicare claims, spinal fusion went from costing Medicare $343 million in 1997 to $2.24 billion in 2008. And as the Journal points out, the screws used in spinal fusion implants can cost between $1,000 to $2,000 apiece for reimbursement but actually turn out to cost less than $100 to make.”

Given such situations, is it then unfair of me to wonder if such financial aspects of medical care could account for why the medical community is not more forthcoming with cost-solutions? And would it be unfair of me to question the contributions of the medical community and the medical insurance industry to politicians? And is it fair to ask whether the Citizens United decision of the Supreme Court facilitates larger contributions to politicians who voted to repeal the entire ACA?

I consider the term, “medical community” to include medical insurance companies and their affiliates, one of which is a company named “Ceridian“. Ceridian’s mission is to administer COBRA accounts for medical insurance companies. COBRA, in turn, is an acronym for a government program which mandates that insurance be continued for people who, for whatever reason, leave an employer who negotiated health insurance for them and provided a part of the premium. Users of COBRA are required to pick up the employer’s portion themselves, but its main advantage is continued coverage of pre-existing conditions at the previously-negotiated rates.

Image via Wikipedia

Therefore, if you believe the right’s opinion that the cost problem can be solved through private insurance, then consider this example of one COBRA patient with cancer, one Ronald Flanagan. He was scheduled to receive a stem cell transplant surgery that he hoped would save his life when he got notice from Ceridian that his insurance had been cancelled. Why? Because his wife had made an innocent error and under-paid one month’s bill by two cents. Yes, that’s right, 2 pennies. While Ceridian eventually crumpled under pressure of publicity, even then they refused to apologize! The message could not have been more clear: business is business. A more complete version of the story is HERE.

Anson says we should expect our doctor to give us EOL counseling at ZERO additional charge, so I pose this question? Which of these options is most likely to result in the best EOL counseling? (And by “best”, I mean best for the family and the patient.) A family physician (the lowest-paid kind of doctor) who makes $83 per hour, depending on how fast he can process patients and who will make ZERO for the counseling, or a trained counselor who makes $20 per hour and whose sole job is to patiently lay out all the options and ramifications? I contend it is the latter.

Now some might say, and Sarah Palin would be first in line, that independent counselors might also be incentivized by the government to minimize costs by recommending hospice over expensive efforts to briefly prolong life. But I say that transparency of process could overcome this, whereas the issue of conflict-of-interest concerning doctors is nowhere near resolution. Any attempts to control that are likely to be contested with utmost vigor by the AMA and similar groups and PAC’s.

Here’s my bottom line to all this. Healthcare is an industry in which the costs (and profits) have year after year after year grown faster than GDP, and in which there is NO incentive for the insured customer (the patient) to shop for lower costs. What is happening is unsustainable. For the approximately 40 million uninsured, mainly the young and the poor, there is every incentive to ignore proactive (preventative) healthcare

Dueling Politicians, Oncle Tom via Flickr

until a crisis develops, at which time they may seek aid in the nation’s ER’s where the law mandates treatment regardless of ability to pay. That is the system we have now and the only law ever passed to deal with the problem has just been resoundingly rejected by the GOP, who vow now to gut it financially in the House.

The GOP says they are going to deal with the cost issue. If they say it’s going to be through making health insurance more available across state lines, are you going to be convinced? I’m not.

Here’s what I recommend:

Politicians, MAN UP, and come up with a system that incentivizes the patient to shop around for non-emergency health care with cost in mind.

The government should subsidize medical education for the most talented applicants so they don’t graduate with massive debt, and should demand a term of service in appropriate areas and set salaries in return for same, just as the service academies do.

And, I say that Sarah Palin’s scare tactic about “death panels” is pure demagoguery that damages America. It’s bogus. Reinstate MediCare payment for counseling at end of life.

And if you expect the health insurance companies to have any compassion for you, go read Ronald Flanigan’s story again.

20 Responses to Health: A Caring Business?

I have a couple of comments. They come from my recent experience in training to become and practicing as a minister. First, the high cost of education is a problem that I believe deserves more attention. There has been an unholy alliance between schools and banks. Schools get to raise their tuition (allowing them to spend more money and also appear to be more prestigious), and banks get their hooks into consumers even earlier enslaving them to the never-ending process of funding banks’ bottom line (previously this had occurred only through mortgages and car loans). The problem is that all sorts of students graduate with an astounding amount of debt, and this quickly focuses their attention on making money rather than any form of meaningful service.

Second, I have been involved with many families and individuals as they deal with end of life decisions. Hospice care has been universally praised by those who had the privilege of experiencing it. It is appreciated because it has a different focus than end of life care at a hospital. Hospice is focused on making the patient comfortable and allowing them to die with dignity. Hospitals are focused on saving lives. This sounds noble, but in my experience it amounts to self-interest. They get to order up more procedures that are costly. It feeds their competitive spirit of wanting to win against death. It makes them feel more secure against malpractice claims.

As for hospice, I have personal experience with that and I completely agree with your sentiments on it. Discussing it causes me to recall an episode from an old work of fiction that I read back in the 1950’s called “Not As A Stranger”, by Morton Thompson. It was later made into a major movie. Anyhow, it was the story of a young doctor who was embarking on his medical career in a small hospital. Upon finding that it was common practice to pretty much ignore pneumonia symptoms in the very old and let them die, he resolved that his was his duty to preserve life. He worked tirelessly over several days and nights to save the life of one such woman only to later realize that he had preserved life without quality.

I don’t think most doctors or hospitals have any nefarious motives about EOL, at least not consciously. But there is surely a strong financial motivation on the business end to keep expensive machines in regular use. In many cases it’s not so much about profit, but financial survival in the wake of having purchased the machines in the first place. It is a positive feedback loop, as we engineers say.

Please stay in touch. I value your perspective as a minister, especially in matters like this one.

Not unexpectedly you took my column much too far. I was ONLY addressing (and said so) a very small portion of the cost of medical care. That was simply the cost involved in receiving EOL COUNSELING, not all the actions needed to provide a basis for such counseling such as testing, medications, etc.

If my primary care physician suspected I had cancer she would charge for that visit to her office and refer me to the appropriate specialist. He would then charge me for consultation visits and refer me to a battery of labs, etc for testing for which I would be charged. I would then return to the specialist (oncologoist) for explanation of test results and recommendations for future treatement which again would require payment. All well and good as far as payment goes thus far.

But now the time is there to make a decision. Do I decide to undergo chemo, radiation, surgery, etc or do I ask, “what are the consequences if I simply go home” and live my life as best I can until…..?”

It is the counseling in response to that question that I was writing about. Maybe it would take an hour for the doctor to answer the questions as completely as possible. Then I and my family (if I chose to let them in on the secret) would have the necessary information to make an informed decision.

And providing that information by the physician is the ONLY cost that I suggest should be absolutely free with no charges or strings attached. That was my very simple point, and only that point.

No it would not save a lot of money. An office visit for such consultation might only cost a $100 or so. But who would pay for such costs of consultation is a huge debate today. My solution is there should be no such costs involved.

As I closed in the column, it would not save much money but it would stop the rancor over payment of EOL counseling.

For now Reps do not want government to pay for such counseling. Dems want government to foot the bill. My very simple point is that there should be no such bill for such counseling thus end of argument on that small point.

Thanks for putting that in context. Apparently you agree that most EOL situations are more complicated than the limited one you describe. A great many arise while the patient is already in the ICU and the pressure is on everyone, doctor and family alike. Often, of course, it’s too late then for the patient to participate rationally. As you can likely see I have a good deal of frustration built up in me over the larger context of EOL care and hospice and I seized the opportunity to expound on it. I was glad you raised the subject and appreciate the concise way you framed the principal issues.

I have personally been through the limited kind of experience you describe. In my case it was prostate cancer. My primary doctor referred me to a urologist, with whom I had about 10 minutes’ face time and who provided me with a handful of pamphlets and a reading list. The urologist referred me to a radiologist who also spent about 10 minutes with me. We agreed on a course of treatment (which was successful, so far anyway), and away we went. I was billed for each of those visits, but those were not EOL situations of course. And I have to say that what you recommend in your column will not stop or even slow the debate over the major EOL issue.

BTW, I very much like my primary care doctor and have a very good relationship with him, but I am struck by the frustrating nature of the system with which both of us are forced to contend. It is all about through-put in limited time. The more patients he can see in a day, the more he is rewarded financially. I know he doesn’t like that any more than I do. The system stinks.

If you have any views about the larger issues, and in particular the cost issues that I raised in my post, I would surely welcome them.

Excellent, Jim. I would disagree that the “death panel” notion is bogus, however. Palin’s comment was pure hyperbole (which she is expert at providing, on just about any topic) but the fact remains that, as written, the health care reform Act will lead quickly to a kind of rationing none of us has ever imagined possible – and it will be very subtle because denial of care is an actionable legal matter. Most of the new legislation consists of pilot programs which may or may not result in any benefit whatsoever to anyone other than the health care industries. That, is a fact – and I am glad my warranty is running out before my family finds it necessary to keep me alive under it.

Anecdote, apropos of: “… a system that in my opinion is deeply flawed because by its very nature it enables conflicts of interest and lacks competition.”

I had a heart attack in August 2008, which ended up costing $10,000 all-told. With the exception of roughly $350, my VA coverage reimbursed all hospital and ambulance expenses, painlessly and quickly. Why not the $350? It was a charge added to the invoice by a physician’s collective, located somewhere in Utah, in which a doctor who visited me bedside for (approximately) 7 minutes was employed. Their invoice was submitted to the VA along with all the others. But, VA kicked it out, for their own reasons. I began to receive dunning calls from Utah, asking me to find out why VA made that decision. My response was that they should ask VA themselves.

I took the view, rightly I believe, that if VA (of all possible organizations) deemed that charge unpayable, then it is unpayable. I can testify that being asked how I was feeling by a guy in a white jacket with embroidered name holding a clip board did not seem to be worth $350, then or now.

My credit rating now shows failure to pay a debt. It went from 809 down to the 600s, overnight – not that I give a crap. Except that from now on, for such things as what household/auto insurance premiums I pay, I will be paying more because I am deemed a “credit risk.”

So, one thing the health care Act could have done to actually be of help to normal people would have been to make it so that anyone being admitted to or cared for in a hospital does NOT have to sign that little piece of paper agreeing to ANY decisions made by the hospital as to care, and to PAY for every bit of it even when one did not really need an internal exam to suture up a nasty wound.

The GOP tried and tried and tried to do all manner of things with that Act while it was being drafted and passed. They even begged the President and Democrats to break it down into manageable sections, and to include Tort reform and several other very sensible measures. They begged the Democrats to not show favoritism toward labor Unions. They warned and warned and warned that States cannot possibly afford huge mandated increases in Medicaid costs. Because it is such stupidly faulty legislation there have already been more than 700 waivers granted to American businesses in the past 6 months. In short the damn Democrats forced the thing through, apparently for no better reason than to later be able to declare that they had performed the miracle of giving America health care reform. None of them, had read or understood the Bill before it passed. They keep saying that giving seniors $250 for their donut hole, and keeping kids on family insurance until age 26 is so special. They also say that denial of insurance for pre-existing conditions is good for us – which it would be IF we could prevent insurance companies from getting out of the business.

It will probably help bankrupt us all, and when it does the Democrats will blame the GOP for that. I have never been so disgusted with Democrats as since this disaster took place. And, what is more, I sincerely hope that as the consequences roll in over the coming few years, the Democrat party will be put out of business permanently and forever.

I find it interesting that you apparently had a good outcome from what is essentially socialized medicine, i.e., VA insurance and VA-negotiated rates. It should be instructive that the tax-payer (VA) funding that paid for your care, even though the full amounts billed are always reduced, was inflated to help pay for all the care that hospitals and doctors give to the uninsured who enter the “system” through the nation’s ER’s, and who likely get the same quality of care that you did. You paid for your part by contracting with the defense department when you signed up to serve. The ER people didn’t. So, before you wish the Democrat opposition totally destroyed I urge you to reflect just what kind of system that will lead to. IMHO, that would be an even worse financial disaster.

I agree that the Democrats set out to design a horse and produced a camel, but that shouldn’t stop us from re-designing it for the long race ahead. I’m not sure what a one-party system would look like, but I am sure I wouldn’t like it. And I am confident that you would not survive another heart attack under a system designed by Republicans alone.

On re-reading you first paragraph, I realize I skipped your comment about “rationing”. That is something everyone fears, but I want to emphasize that we simply can not afford everything the system can offer. Some decision-making process MUST control (read: ration) the costs involved in the process. It is not enough to simply rail against rationing without putting in place some limiting decision-making process. It is my position that NO bureaucratic system can do that and be judged FAIR by all parties. Ergo, an acceptable system MUST contain the element of competition, a.k.a., capitalism.

“It is my position that NO bureaucratic system can do that and be judged FAIR by all parties. Ergo, an acceptable system MUST contain the element of competition, a.k.a., capitalism.”

Exactly. And, it would seem, we somehow got away from that AS we more and more increased public control and financing of the system. What we have now does not, as you pointed out earlier, permit of local hospital/doctor/patient arrangements for necessary health care, AND it encourages extravagant emphasis on tending to the requirements of those who use the system more than most of us choose to do.

Right, Wing. Now I hope you realize that under a capitalistic health-care system there will be rationing. The rationing will occur naturally because you will not be able to afford all that has been invented

I would go further by saying that rationing already exists as much as it is going to become more so, and I have grown accustomed to that – by denying myself some care that I know might be available which could potentially extend my life and quality of life. The VA system is usually good in that way. They do not grant everyone everything they ask for, nor are they able to, nor is it always within reach. But, for basic things (my hearing aids and medicines and annual check up/blood work ups for example), they are always there for me. If I get in real hot water (e.g. heart attack), they tell me to go to the nearest emergency room, and then they negotiate payment with the hospital/providers after-the-fact.

Better that, I’d say, than for tax payers to be covering the $63,000 cost of a First Lady flying 2,000 miles to vacationland because it was inconvenient for her to wait a couple of days for Air Force One to haul them out there – not to pick on her. Or for her husband (and most Presidents) to use Air Force One for what are essentially political party campaign junkets.

🙂
“I agree that the Democrats set out to design a horse and produced a camel, but that shouldn’t stop us from re-designing it for the long race ahead. I’m not sure what a one-party system would look like, but I am sure I wouldn’t like it. And I am confident that you would not survive another heart attack under a system designed by Republicans alone.”

You can rest assured that neither would I want to see either a one-party system (a genuine TWO-party system would be a nice change, however) nor for the Rightist conservative aristocracy to be any more in charge of this hopeful nation than it already is (was, and will remain, I hasten to add).

This was a wonderful point to have made, Jim – and I have intended to address it in several of your and Anson’s epistles:

“I find it interesting that you apparently had a good outcome from what is essentially socialized medicine, i.e., VA insurance and VA-negotiated rates. It should be instructive that the tax-payer (VA) funding that paid for your care, even though the full amounts billed are always reduced, was inflated to help pay for all the care that hospitals and doctors give to the uninsured who enter the “system” through the nation’s ER’s, and who likely get the same quality of care that you did.”

I would reply on that major point, that what is dangerous is not socialized medicine, but rather Socialized medicine > which is exactly what the Democrats have imposed upon us. And, unlike veteran’s benefits which were pretty much unanimously approved in Congress and by voters, this ludicrous health care reform Act almost incited an armed insurrection at town hall meetings – and the contest is still to be decided (I’m looking for it to get real dicey when States start going bankrupt and the SEIU gets in the streets over that).

Yes, I did sign that proverbial blank check for an amount up to and including my life, and earned an E-2 $52 a month in return – without complaint. I’d do it again this afternoon, even if they had never offered to spare me some medical worries. Considering that not more than 5% of our fellow citizens sign up for that honor, I’d say we all got a bargain; as I know you would agree.

I do want to say this: As far as incentivizing patients to shop around for cheaper services, my private insurance company pretty much controls the cost of services by negotiated arrangements. In one case last year, the cost of my wife’s outpatient surgery (non-emergency) was reduced by about, I think, 60% or more! We were billed X and the insurance company said we will only pay Y. End of story. Now, I don’t think I could have come out any better by myself. So, I don’t quite understand how acting on my own as a consumer that I would have come out better. There is negotiating power in numbers and one is not much negotiating power.

And I would further ask this: If shopping around would decrease cost because of the power of consumers to choose better options, why wouldn’t a government-run insurance entity (competing with private insurers) have the power to negotiate down costs even further? I mean, the enrollment in such an entity would likely be enormous and the government could do what my insurance company did in my case? Thus, collectively, consumers would have the power to “shop around,” no?

Or are you saying that the real cost of medical services is inflated by the current system and everything would necessarily come down with, say, a medical voucher system? I’m just trying to understand how an individual could meaningfully be empowered to hold down costs.

And for the record, your summary of Anson’s piece made his points better than he did, especially the death panel nonsense. Anson could have improved his article by using Palin’s characterization as part of the problem he was trying to explain. You rightly pointed out that insurance companies find all kinds of ways to ration care without a peep from the Right.

And I never saw a rebuttal to your point about a commenter’s availing himself of socialized medicine and yet criticizing as a “disaster” Democratic efforts to improve the system. I just wonder what someone who is a participant in socialized medicine would have said if the Democrats would have had the guts to propose health care for all, similar to the VA system or Medicare?

Finally, if anyone wants to see what a world would look like with GOP health care solutions, a preview is available in Arizona, where folks with dire transplant needs are left to die because the state has refused to pay for the procedures.

“And I never saw a rebuttal to your point about a commenter’s availing himself of socialized medicine and yet criticizing as a “disaster” Democratic efforts to improve the system…”

a. I did not offer a rebuttal. I did reply that there is a difference between “socialized” medicine and “Socialized” medicine.

b. Democrats made no effort at all to “improve the system.” At best, they did as Jim described, created one thing while intending (and miserably failing) to create another. It is by now documented fact (see: FRONTLINE archives) that even before the legislation was drafted it had been found necessary to construct it so as to benefit the health INDUSTRY and pharmaceutical corporations.

c. This afternoon another Federal judge determined that the damn thing is unconstitutional. This is where “Socialized” medicine comes into play – it would not have been deemed unconstitutional if it had not been Socialist.

The legal challenges to the health overhaul law have gone from quixotic to indisputably serious with U.S. District Judge Roger Vinson’s blockbuster decision on Monday declaring the entire law unconstitutional.

The White House reportedly was caught off guard, but quickly “went into a full convulsive rage” at Vinson, Jonathan Turley of George Washington University writes in USA Today.

Turley writes that the administration was ultimately to blame. He says the White House “played a game of chicken over health care with the court and lost a critical battle in Florida. Instead of inserting a ‘severability clause’ designed to protect an act from this type of global rejection, the legislation was rammed through a divided Congress with diminishing public support.”

“Even for some of us who support national health care, the bill unnecessarily triggered the constitutional fight that led to its rejection in two federal courts … Even if one accepts that the removal of the clause was just some colossal, inexplicable blunder, it was the blunder of the White House and Congress — not the courts,” Turley, a supporter of the health overhaul effort, writes.
Small hr

So what’s next? Florida and Wisconsin, two of the 26 states that were plaintiffs in the Florida case, have said they believe it means they don’t have to implement the law, although at least Wisconsin seems to be backing off that position today. The Florida decision likely means that the higher Circuit Courts of Appeals and ultimately the U.S. Supreme Court will be asked to accelerate their rulings.

White House “rage” and partisan attacks aside, Judge Vinson’s decision is gaining widespread respect for his “exhaustive and erudite opinion [that] is an important moment for American liberty,” according to an excellent Wall Street Journal editorial.

We have argued for the entire 15 year history of the Galen Institute that the struggle over control of our health sector is THE fight for freedom of our generation. And the individual mandate is the apex of that battle because it goes to such a fundamental question of control over our life and liberty.

The main defense from the other side, so far as I can tell, is this: Our nation has a health care crisis. The only way to solve it is with a centralized, government micromanaged overhaul. For this Rube Goldberg apparatus to work, the government must force everyone to buy health insurance. Therefore, because we need health reform, it is “necessary and proper” — and therefore constitutional — for the government to force us all to buy health insurance.

The court didn’t buy it. “Because the individual mandate is unconstitutional and not severable, the entire Act must be declared void,” Vinson concluded.
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Senate repeal effort: The Senate debated an amendment to repeal ObamaCare that Republican Leader Mitch McConnell brought to the floor this week. Every Republican voted for repeal (47) and all 51 Democrats present voted to keep the law in place. (Sens. Lieberman and Warner were absent.) This is going to make for some very uncomfortable ads for the 22 Democratic senators up for re-election next year.

During the debate, defenders of the law talked about people losing early benefits of the law as a way of justifying upholding the whole thing. But people just aren’t buying it. Congress can enact any useful and helpful provisions separately without the avalanche of spending and mandates barreling down at us.

And it could certainly better spend $5 billion to help the uninsured with pre-existing conditions than through ObamaCare’s program that is helping just 8,000 people (of the estimated 375,000 that were expected to enroll as of December).

My calculations show that, at this rate, we would be paying more than $625,000 each for these 8,000 people to get health insurance for four years when the program expires. There clearly is a better way.

And as to the 25-year-olds on their parent’s policies, insurers could still write those policies, but people would pay for them. That would be better than having tens of thousands of people lose coverage because their employers drop dependent coverage altogether, as many are doing.

The Senate did vote on Wednesday to repeal the despised 1099 mandate that would hit approximately 40 million businesses with an avalanche of paperwork. The House will act on this, but since it doesn’t take effect until 2012, it has time.

This is the first crack in ObamaCare’s armor. Many more will come as people learn more about what really is in this law.
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Political fallout: Several experts I’ve spoken with expect the Supreme Court to take up this case in its 2011-2012 term. If it were to issue a ruling saying ObamaCare is unconstitutional, this would likely diminish its impact as a hot political issue in the 2012 elections.

But if the Supreme Court were to declare the law constitutional, then it could light a fire under the political impetus to elect a new president and a Republican Senate to overturn it legislatively.

So perversely, the Obama administration could have a vested interest politically that the Supreme Court rule ObamaCare unconstitutional.

Am I missing something here?”
————

Difficult to say how this will play out. It’s rather like the habitual drunk pleading “Not Guilty” at the tenth DUI hearing…

I hasten to say, again and emphatically, that I have zero confidence in any solutions the GOP may offer or be allowed to pass. Though on fiscal matters I tend to trust them more than Democrats (except when the GOP capitulates another time to the aristocracy), there can be no doubt that their conduct is every bit as responsible for our mess as anyone else’s. It was, after all, the GOP tax cut at the beginning of two wars which, in my opinion then and today, made it inevitable for us to be in this economic disaster which we might otherwise have survived.

Their 100% resistance to the health care reform Act as proposed, will always be one of their brightest moments in recent memory, however. Not that it did any good for us to have them resist.

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